application form for recruitment of prasar bharati...

Annexure - I

Application form for recruitment of Prasar Bharati vacancies

Post applied for:

Post Code:

(Candidate should opt for only ONE post)

Tick on applicable category

VH HH

OH

Examination Centre (Choose any one from Delhi/Mumbai/Chennai/Kolkata/Guwahati)

1. Name (IN

BLOCK LETTERS) _________ _______________ ____________ (Surname) (First Name) (Middle Name)

2. Mother’s Name

3. Father’s Name

4. Date of Birth

Affix recent Passport size photograph

Signed across in full

5. Place of Birth

6. Marital Status Married Unmarried

7. Gender Male Female Others

8. Nationality

9. Category (SC/ ST/OBC/Others)

10. (a)

Languages known

Language

Understand Spoken

Speak Read Write

10. (b)

Languages Studied upto matriculation level

(1)

11. E-mail ID

12. Contact Numbers

Mobile: Landline:

13. Address Present Mailing:

Permanent:

14. Have you ever been convicted by a Court of Law? Is there any legal case filed against you in a Court of Law? If yes, provide details (attach extra sheets, if required).

Yes/No

15. *Zone Code: For Post Code 13 only. (see section 1.2)

*Candidates should opt for only one Zone.

16. Educational Qualifications:

Sl. No.

Qualification Discipline/ Specialization

University/ College/Institute

Year of Passing

Percentage

1.

2.

3.

4.

5.

17. Software skill

18. Awards

(2)

19. Experience:

Sl. No.

Organization Designation Period Field of Work Experience

Salary Drawn

Reasons for leaving

1.

2.

3.

4.

5.

(May add sheet, if required)

20. Copies of Testimonials attached with the application (Please list them).

1.

2.

3.

4.

5.

6.

7.

8.

9.

21. If VH/ Cerebral Palsy candidate, whether, services of scribe will be utilized.

YES/NO (Tick the correct option)

22. Any other Information

DECLARATION: I hereby declare that all the statements made in this application are true, complete and

correct to the best of my knowledge and belief. I understand that in the event of any information

being found suppressed/false or incorrect or ineligibility being detected before or after the

examination, my candidature/ appointment is liable to be cancelled.

Place…………………….

Date:

(Signature of the Candidate)

(3)

Annexure – I A

(To be printed on separate sheet of paper)

ADMIT CARD

*Roll Number

PWD Category (VH/HH/OH)

Post applied for

Post Code:

NAME

Gender (Male/Female/Others)

E-mail address:

Affix recent Passport size photograph

Signed across in full

Mobile Number

Postal address: (IN BLOCK LETTERS)

*Examination Venue

*Will be allotted by office

Annexure - II

Syllabus for Assistant Director (Engineering) Post Code (01)

Paper – I (Objective Type)

GENERAL ABILITY TEST

Part A: General English. The question paper in General English will be designed to test the

candidate’s understanding of English and workmanlike use of words.

Paper B: General Studies. : The paper in General Studies will include knowledge of current events and

of such matters as of everyday observation and experience in their scientific aspects as may be

expected of an educated person. The paper will also include questions on History of India and

Geography of a nature which candidates should be able to answer without special study.

Paper – II (Objective Type)

ELECTRONICS & TELECOMMUNICATION ENGINEERING

Materials and Components

Structure and properties of Electrical Engineering materials: Conductors, Semiconductors and

Insulators, magnetic, Ferroelectric, Piezoelectric, Ceramic, Optical and Super-conducting materials.

Passive components and characteristics Resistors, Capacitors and Inductors; Ferrites, Quartz crystal

Ceramic resonators, Electromagnetic an Electromechanical components.

Physical Electronics, Electron Devices and ICs

Electrons and holes in semiconductors, Carrier Statistics, Mechanism of current flow in a

semiconductor, half effect, Junction theory; Different types of diodes and their characteristics;

Bipolar Junction transistor, Field effect transistors; Power switching devices like SCRs, CTOs, power

MOSFETs; Basics of ICs – bipolar, MOS and CMOS types; basic of Opto Electronics.

Signals and Systems

Classification of signals and systems : System modelling in terms of differential and difference

equations; State variable representations; Fourier series; Fourier transforms and their application to

system analysis; Laplace transforms and their application to system analysis: convolution and

superposition integrals, and their applications; Z-transforms and their applications to the analysis and

characterization of discrete time systems,; Random signals and probability, Correlation functions;

Special density; Response of linear system to random inputs.

Network theory

Network analysis techniques: Network theorems, transient response, steady state sinusoidal

response; Network graphs and their applications in network analysis ; Telliegen’s theorem. Two port

networks; Z, Y, h and transmission parameters. Combination of two ports, analysis of common two

ports. Networks functions : parts of network functions, obtaining a network function from a given

part. Transmission criteria ; delay and rise time. Elmore’s and other definitions effect of cascading.

Elements of network synthesis.

Electromagnetic Theory

Analysis of electrostatic and magneto static fields; Laplace’s and Piossons’s equations : Boundary

value problems and their solutions; Maxwell’s equation application to wave propagation in bounded

and unbounded media; Transmission lines : basic theory, standing waves, matching applications, mis-

construe lines; Basics of wave guides and resonators, Elements of antenna theory.

Electronic Measurements and Instrumentation

Basic concepts, standards and error analysis; Measurements of basic electrical quantities and

parameters, Electronic measuring instruments and their principles of working ; analog and digital,

comparison, characteristics, application, Transducers, Electronic measurement’s of non electrical

quantities like temperature, pressure, humidity etc. basics of telemetry for industrial use.

Analog Electronic Circuits

Transistors biasing and stabilization. Small signal analysis. Power amplifiers, Frequency response,

Wide banding techniques, Feedback amplifiers, Tuned amplifiers, Oscillators. Rectifiers and power

supplies. OP Amp PLL, other linear integrated circuits and applications Pulse shaping circuits and

wave-form generators.

Digital Electronic Circuits

Transistors as a switching element; Boolean algebra, simplification of Boolean functions, Karnaguh

map and applications, IC Logic gates and their characteristics : IC logic families : DTL, TTL, ECL, NMOS,

FMOS and CMOS gates and their comparison ; Combinational logic Circuits, Half adder, Full adder,

Digital comparator ; Multiplexer Demultiplexer, ROM and their applications. Flip flops, R-S, J- K, D

and T flip-flips ; Different types of counters and registers Waveform generators. A/D and D/A

converters. Semiconductor memories.

Control Systems

Transient and steady state response of control systems; Effect of feedback on stability and sensitivity;

Root locus techniques; Frequency response analysis. Concepts of gain and phase margins: Constant-

M and Constant-N Nichol’s Chart, Approximation of transient response from Constant N Nichol’s

Chart, Approximation of transient response from closed loop frequency response; Design of Control

Systems, Compensators; Industrial controllers.

Communication Systems

Basic information theory; Modulation and detection in analogue and digital systems; Sampling and

data reconstructions; Quantization & coding; Time division and frequency division multiplexing,

Equalization, Optical Communication; in free space & fiber optic, Propagation of signals at H F, VHF,

UHF and microwave frequency; Satellite Communication.

Microwave Engineering

Microwave Tubes and solid state devices, Microwave generation and amplifiers, Waveguides and

other Microwave Components and Circuits, Misconstrue circuits, Measurements, Masers, lasers,

Microwave propagation, Microwave Communication Systems terrestrial and Satellite based.

Computer Engineering

Number systems. Data representation, Programming; Elements of a high level programing language

PASCAL/ C; Use of basic data structures; Fundamentals of computer architecture; Processor design;

Control unit design; Memory organization, I/o Systems Organization. Microprocessors: Architecture

and instruction set of Microprocessors 8085 and 8086. Assembly language Programming.

Microprocessor Based system design: typical examples. Personal computers and their typical uses.

Annexure - III

Syllabus for Assistant Director (Program) (Post Code -02)

Paper I (Objective type)

(a) General Intelligence & Reasoning

It would include questions of both verbal and non-verbal type. This component may

include questions on analogies, similarities and differences, space visualization, spatial

orientation, problem solving, analysis, judgement, decision making, visual memory,

discrimination, observation, relationship concepts, arithmetical reasoning and figural

classification, arithmetic number series, non-verbal series, coding and decoding,

statement conclusion, syllogistic reasoning etc. The topics are, Semantic Analogy,

Symbolic/Number Analogy, Figural Analogy, Semantic Classification, Symbolic/Number

Classification, Figural Classification, Semantic Series, Number Series, Figural Series,

Problem Solving, Word Building, Coding & de-coding, Numerical Operations, symbolic

Operations, Trends, Space Orientation, Space Visualization, Venn Diagrams, Drawing

inferences, Punched hole/pattern –folding & un-folding, Figural Pattern – folding and

completion, Indexing, Address matching, Date & city matching, Classification of centre

codes/roll numbers, Small & Capital letters/numbers coding, decoding and classification,

Embedded Figures, Critical thinking, Emotional Intelligence, Social Intelligence, Other

subtopics, if any.

(b) General Awareness

General Awareness will examine understanding of the topical events and happenings with

special emphasis on the cultural profile of the country.

Paper II (Descriptive type)

(a) General English/ Hindi

English: Questions in this components will be designed to test the candidate’s

understanding and knowledge of the Language and will be based on spot the error, fill in

the blanks, synonyms, antonyms, spelling/detecting mis-spelt words, idioms & phrases,

one word substitution, improvement of sentences, active/passive voice of verbs,

conversion into direct/indirect narration, shuffling of sentence parts, shuffling of

sentences in a passage, cloze passage & comprehension passage.

Hindi: This could be in the form of essay/ letter writing, précis, language comprehension

passages, fill in blanks with correct application of words

(b) General Aptitude

Creative Aptitude will include Logical Reasoning, Problem solving, Data Interpretation,

Pattern Recognition and Subjective Questions on Creativity

Annexure - IV

Syllabus for Programme Executive (PEX), Transmission Executive (Production Asstt.)

Transmission Executive (TREX) (G&P), (Post Code 04, 05 & 06)


(a) General Intelligence & Reasoning















subtopics, if any.

(b) General Awareness

General Awareness will examine understanding of the topical events and happenings with

special emphasis on the cultural profile of the country.

Paper II (Descriptive type)

(a) General English/ Hindi

English: Questions in this components will be designed to test the candidate’s

understanding and knowledge of the Language and will be based on spot the error, fill in

the blanks, synonyms, antonyms, spelling/detecting mis-spelt words, idioms & phrases,

one word substitution, improvement of sentences, active/passive voice of verbs,

conversion into direct/indirect narration, shuffling of sentence parts, shuffling of

sentences in a passage, cloze passage & comprehension passage.

Hindi: This could be in the form of essay/ letter writing, précis, language comprehension

passages, fill in blanks with correct application of words

(b) General Aptitude (Descriptive type)

Creative Aptitude will include Logical Reasoning, Problem solving, Data Interpretation,

Pattern Recognition and Subjective Questions on Creativity

Annexure - V

Syllabus for Cameraman Gr. II and Cameraman Gr. III, Graphic Artist, Makeup

Assistant, Film/Video Editor) (Post Code 03, 07,08, 09 & 10)

General Intelligence & Reasoning

(Objective type)















subtopics, if any.

Subject Specialisation

(Objective type)

The questions will gauge the candidate’s technical knowledge on the relevant subject and

his potential for creative and practical application.

Skill test

Skill test will aim to test the candidate’s proficiency in handling the equipments his

practical knowledge with focus on the creative temperament as best suited to the media

he is being considered.

Annexure - VI

Syllabus for Library & Information Assistant and Floor Assistant (Post Code (11 & 12)

General Intelligence & Reasoning

(Objective type)















subtopics, if any.

Subject Specialisation

(Objective type)

The questions will gauge the candidate’s technical knowledge on the relevant subject and

his potential for creative and practical application.

Annexure - VII

Syllabus for Technician Post Code (13)


Part (a).

General Intelligence & Reasoning : It would include questions of both verbal and non-verbal type.

This component may include questions on analogies, similarities and differences, space visualization,

spatial orientation, problem solving, analysis, judgement, decision making, visual memory,

discrimination, observation, relationship concepts, arithmetical reasoning and figural classification,

arithmetic number series, non-verbal series, coding and decoding, statement conclusion, syllogistic

reasoning etc. The topics are, Semantic Analogy, Symbolic/Number Analogy, Figural Analogy,

Semantic Classification, Symbolic/Number Classification, Figural Classification, Semantic Series,

Number Series, Figural Series, Problem Solving, Word Building, Coding & de-coding, Numerical

Operations, symbolic Operations, Trends, Space Orientation, Space Visualization, Venn Diagrams,

Drawing inferences, Punched hole/pattern –folding & un-folding, Figural Pattern – folding and

completion, Indexing, Address matching, Date & city matching, Classification of centre codes/roll

numbers, Small & Capital letters/numbers coding, decoding and classification, Embedded Figures,

Critical thinking, Emotional Intelligence, Social Intelligence, Other sub-topics, if any.

Part (b)

General Awareness: Questions in this component will be aimed at testing the candidate’s general

awareness of the environment around him and its application to society. Questions will also be

designed to test knowledge of current events and of such matters of every day observations and

experience in their scientific aspect as may be expected of any educated person. The test will also

include questions relating to India and its neighbouring countries especially pertaining History,

Culture, Geography, Economic Scene, General Polity & Scientific Research.

Paper – II : (Objective type)

The questions will be of Diploma level.

Annexure - VIII

FORMAT FOR SC/ST CERTIFICATE

A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should

submit in support of his claim an attested/certified copy of a certificate in the form given below,

from the District Officer or the sub-Divisional Officer or any other officer as indicated below of the

District in which his parents (or surviving parent) ordinarily reside who has been designated by the

State Government concerned as competent to issue such a certificate. If both his parents are dead,

the officer signing the certificate should be of the district in which the candidate himself ordinarily

resides otherwise than for the purpose of his own education. Wherever photograph is an integral

part of the certificate, the Commission would accept only attested photocopies of such certificates

and not any other attested or true copy of such certificates.

(The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates

applying for appointment to posts under Government of India)

This is to certify that Shri/Shrimati/Kumari* __________________________ son/daughter of

___________________________________ of village/town/* in District/Division*

_______________________ of the State/Union Territory* ________ belongs to the

Caste/Tribes_______________ which is recognized as a Scheduled Castes/Scheduled Tribes*

under:-

The Constitution (Scheduled Castes) order, 1950 ___________________

The Constitution (Scheduled Tribes) order, 1950 ________________

The Constitution (Scheduled Castes) Union Territories order, 1951 * _______________

The Constitution (Scheduled Tribes) Union Territories Order, 1951*______________

As amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) order, 1956,

the Bombay Reorganization Act, 1960 & the Punjab Reorganization Act, 1966,

the State of Himachal Pradesh Act 1970, the North-Eastern Area(Reorganization) Act, 1971 and the

Scheduled Castes and Scheduled Tribes Order(Amendment) Act, 1976.

The Constitution (Jammu & Kashmir) Scheduled Castes Order, 1956___________

The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended

by the Scheduled Castes and Scheduled Tribes order (Amendment Act), 1976*.

The Constitution (Dadra and Nagar Haveli) Scheduled Castes order 1962.

The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order 1962@.

The Constitution (Pondicherry) Scheduled Castes Order 1964@

The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967 @

The Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968@

The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @

The Constitution (Nagaland) Scheduled Tribes Order, 1970 @

The Constitution (Sikkim) Scheduled Castes Order 1978@

The Constitution (Sikkim) Scheduled Tribes Order 1978@ 28

The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@

The Constitution (SC) orders (Amendment) Act, 1990@

The Constitution (ST) orders (Amendment) Ordinance 1991@

The Constitution (ST) orders (Second Amendment) Act, 1991@

The Constitution (ST) orders (Amendment) Ordinance 1996 %

2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from

one State/Union Territory Administration.

This certificate is issued on the basis of the Scheduled Castes/ Scheduled tribes certificate issued to

Shri/Shrimati __________________________Father/mother _____________________________ of

Shri/Srimati/Kumari*___________________________ of village/town*____________

___________________ in District/Division* ______________________of the State/Union

Territory*______________________________ who belong to the

________________________________ Caste/Tribe which is recognized as a Scheduled

Caste/Scheduled Tribe in the State/Union Territory* issued by

the_______________________________ ____dated____________________________%

3.Shri/Shrimati/Kumari ____________________________ and /or * his/her family ordinarily reside(s) in village/town*________________________________________ of ________________ District/Division* _________________of the State/Union Territory of ____________________________

Signature__________________________

** Designation________________________

(with seal of office)

Place______________

Date_______________

* Please delete the words which are not applicable

@ Please quote specific presidential order

% Delete the paragraph which is not applicable.

NOTE: The term ordinarily reside(s) used here will have the same meaning as in section 20 of the

Representation of the People Act, 1950.

** List of authorities empowered to issue Caste/Tribe Certificates:

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional

Deputy Commissioner/Dy.Collector/Ist Class Stipendiary Magistrate/Sub-Divisional

Magistrate/ExtraAssistant Commissioner/Taluka Magistrate/Executive Magistrate.

(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. (iii)

Revenue Officers not below the rank of Tehsildar.

(iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.

NOTE: ST candidates belonging to Tamil Nadu state should submit caste certificate ONLY FROM THE

REVENUE DIVISIONAL OFFICER.

Annexure-IX

(FORMAT OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR

APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA)

This is to certify that _______________________________ son/ daughter of

___________________________________________ of village _____

______________________________ District/Division _____________________ in the

______________________________ State __________________________ ________ belongs to the

______________________________ Community which is recognized as a backward class under:

i. Resolution No. 12011/68/93-BCC dated the 10th September, 1993, published in the Gazette

of India Extraordinary – Part I, Section I, No. 186 dated 13th September, 1993.

ii. Resolution No. 12011/9/94-BCC, dated 19.10.1994 published in Gazette of India

extraordinary Part I Section I No. 163, dated 20th October, 1994.

iii. Resolution No. 12011/7/95-BCC dated the 24th May 1995 Published in the Gazette of India

extraordinary Part-I Section I No. 88 dated 25th May, 1995.

iv. Resolution No.12011/96/94-BCC dated 9th March, 1996.

v. Resolution No. 12011/44/96-BCC, dated the 6th December, 1996, published in the Gazette of

India – Extraordinary-part I, Section-I, No. 210, dated the 11th December, 1996.

vi. Resolution No.12011/13/97-BCC dated 3rd December, 1997.

vii. Resolution No.12011/99/94-BCC dated 11th December, 1997.

viii. Resolution No.12011/68/98-BCC dated 27th October, 1999.

ix. Resolution No.12011/88/98-BCC dated 6th December, 1999, published in the Gazette of

India, Extra Ordinary Part-I, Section-I No.270, 6th December, 1999.

x. Resolution No.12011/36/99-BCC dated 4th April, 2000, published in the Gazette of India,

Extra Ordinary Part-I, Section-I, No.71 dated 4th April, 2000.

xi. Resolution No.12011/44/99-BCC dated 21.9.2000, published in the Gazette of India, Extra

Ordinary Part-I, Section-I, No.210 dated 21.9.2000.

xii. Resolution No.12011/36/99-BCC dated 4th April, 2000, published in the Gazette of India,

Extra Ordinary Part-I, Section-I, No.71 dated 4th April, 2000. xi) Resolution No.12011/44/99-

BCC dated 21.9.2000, published in the Gazette of India, Extra Ordinary Part-I, Section-I,

No.210 dated 21.9.2000.

xiii. Resolution No.12011/36/99-BCC dated 4th April 2000, published in the Gazette of India,

Extra Ordinary Part.I Section-I No.71 dated 4th April 2000.

xiv. Resolution No.12011/44/99-BCC dated 21-9-2000 published in the Gazette of India, Extra

Ordinary Part-I Section-1 No.210 dated 21-9-2000.

xv. Resolution No.12015/9/2000-BCC dated 06th September 2001 published in the Gazette of

India, Extra Ordinary Part-I Section-1 No.246 dated 06th September 2001.

xvi. Resolution No.12011/1/2001-BCC dated 19th June 2003 published in the Gazette of India,

Extra Ordinary Part-I Section-1 No.151 dated 20th June 2003.

xvii. Resolution No.12011/42002-BCC dated 13th January 2004 published in the Gazette of India,

Extra Ordinary Part-I Section-1 No.9 dated 13th January 2004. 30

xviii. Resolution No.12011/142002-BCC dated 12th March 2007 published in the Gazette of India,

Extra Ordinary Part-I Section-1 No.67 dated 12th March, 2007.

Shri ___________________________________________ and/or his family ordinarily reside(s)

in the __________________________________________ District/Division of the

_______________________________________ State.

This is also to certify that he/she does not belong to the persons/sections (Creamy Layer)

mentioned in column 3 of the Schedule to the Government of India, Department of Personnel &

Training OM No. 36012/22/93-Estt. (SCT,) dated 08.09.1993 and modified vide Govt. of India Deptt.

of Personnel and Training OM No. 36033/3/2004-Estt(Res) dated 09.03.2004 & 14.10.2008.

Dated: ………………………….

District Magistrate or Seal:

Deputy Commissioner etc.

Note-I (a) The term ‘Ordinarily’ used here will have the same meaning as in Section 20 of the

Representation of the People Act, 1950.

(b) The authorities competent to issue Caste Certificate are indicated below:-

i. District Magistrate/Additional Magistrate/Collector/Dy. Commissioner/ Additional Deputy

Commissioner/Deputy Collector/Ist Class Stipendiary Magistrate/ Sub-Divisional

Magistrate/Taluka Magistrate/ Executive Magistrate/Extra Assistant Commissioner (not

below the rank of 1st Class Stipendiary Magistrate).

ii. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/ Presidency Magistrate.

(iii) Revenue Officer not below the rank of Tehsildar

iii. Sub-Divisional Officer of the area where the candidate and/or his family resides.

NOTE-II: The closing date for receipt of application will be treated as the date of reckoning for OBC

status of the candidate and also, for assuming that the candidate does not fall in the

creamy layer.

NOTE-III: The candidate should furnish the relevant OBC Certificate in the prescribed format issued

by the competent authority at the time of interview/document verification.

NOTE-IV: Commission accepts OBC certificates dated till date of Interview/Document verification.

Annexure-X

FORM OF CERTIFICATE TO BE SUBMITTED BY EMPLOYEES OF PRASAR BHARATI SEEKING UPPER AGE RELAXATION

(To be filled by the Head of the Office or Department in which the candidate is working)

It is certified that Shri/Smt./Km.______________________________ is an

employee of Prasar Bharati holding the post of _____________________________

in the pay scale of Rs.______________________ as on 23/12/2015.

He/She is eligible for Age Relaxation for the post of

________________________ and there is no objection to his appearing in

Recruitment for the above post.

Signature___________________

Name_______________________

Official Seal

Place: Date:

Annexure-XI

(Form No. II)

DISABILITY CERTIFICATE

(IN CASE OF AMPUTATION OR COMPLETE PERMANENT PARALYSIS OF LIMBS AND IN CASES OF BLINDNESS)

(See Rule 4)

Recent PP size Attested Photograph

(showing face only) of the person with disability

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt/Kum

______________________ Son/Wife/Daughter of Shri ______________________

Date of Birth ______________________ Age_________ years, Male/Female

________ (DD/MM/YY)

Registration No. _________________ Permanent resident of Home

No._____________________

Ward/Village/Street_________________________Post office___________________

______________________ District ____________________ State

____________________

whose photograph is affixed above, and am satisfied that:

(A) he / she is a case of:

locomotor disability Blindness

(Please tick as applicable)

The diagnosis in his / her case _____________________________

(B) He/She has ______% (in figure)_____________________ percent (in

words) permanent physical impairment / blindness in relation to

his/her__________________ (part of body) as per guidelines (to be

specified).

2. The applicant has submitted the following document(s) as proof of residence:-

Nature of Document Date of Issue Details of authority issuing certificate

(Signature and Seal of Authorised Signatory of notified Medical Authority)

Signature / Thumb Impression of the person in whose favour disability certificate is issued.

Annexure-XII

(Form No. III)


(In case of Multiple disabilities)

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE) (See Rule 4)

Recent PP size Attested Photograph (showing face only) of the person with disability


This to certify that I have carefully examined Shri/Smt/Kum ____________________

Son/Wife/Daughter of Shri ______________ Date of Birth ______________ Age _________ (DD/MM/YY)

years, Male/Female __________________________ Registration No. _______________

permanent resident of Home No.____ Ward/Village/Street _____________ Post Office

______________ District__________________ State whose photograph is affixed above,

and am satisfied that :

(A) He/She is a case of Multiple Disability. His / Her extent of permanent physical

impairment / disability has been evaluated as per guidelines (to be specified) for the

disabilities ticked below, and shown against the relevant disability in the table below:

Disability Affected part of the body

Diagnosis

Permanent physical

impairment / mental disabilities

(in %)

Locomo disability

@

Low vision #

Blindness Both Eyes

Hearing impairment

$

Mental retardation

X

Mental illness X

(B) In the light of the above, his/her over all permanent physical impairment as

per guidelines (to be specified) is as follows:-

In figure _______________________________percent.

In words: ________________________________percent

2. This condition is progressive/non progressive/likely to improve/not likely to

improve.

3. Reassessment of disability is:

(i) not necessary

Or

(ii) is recommended/after________________ years______________

months, and therefore this certificate shall be valid till ___________________

(DD) (MM) (YY)

@ e. g. Left/Right/both arms/Legs # e.g. Single eye/both eyes $ e.g. Left/Right/both ears.

4. The applicant has submitted the following documents as proof of residence:

Nature of Document Date of issue Details of authority issuing certificate

5. Signature and seal of the Medical Authority

Name and seal of Member Name and seal of Member Name and seal of the Chairperson

Signature/Thumb impression of the person in whose favour disability certificate is issued.

Annexure-XIII

(Form No. IV)


(In case other than those mentioned in Forms II and III)

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)

(See rule 4)

Recent PP size

Attested Photograph (showing face only) of the person with

disability.


This is to certify that I have carefully examined Shri/Smt/Kum

_____________________ Son/Wife/daughter of Shri_____________Date of

Birth____________(DD/MM/YY Age ___ years, Male/Female _______ Registration

No. _______________ permanent resident of House No.

____________Ward/Village/Street_____________________________________Post

Office________________District______________ State__________________

whose photograph is affixed above and am satisfied that he/she is a case of

________________________disability. His/Her extent of percentage physical

impairment/disability has been evaluated as per guidelines (to be specified) for the

disabilities (to be specified) and is shown against the relevant disability in the table

below:-

Sl. No.

Disability Affected part of the body

Diagnosis Permanent physical

impairment / mental disabilities

(in %)

1. Locomotor disability

@

2. Low vision #

3. Blindness Both eyes

4. Hearing impairment

$

5. Mental retardation

X

6. Mental illness X

(Please strike out the disabilities which are not applicable)

2. The above condition is progress/non progress/likely to improve/not likely to

improve.

3. Reassessment of disability is:

i) not necessary Or

ii) is recommended/after __________ years __________ on this, and

therefore this certificate shall be valid till ________ ________ _________

(DD) (MM) (YY)

@ e. g. Left/Right/both arms/Legs

# e.g. Single eye/both eyes

$ e.g. Left/Right/both ears.

4. The applicant has submitted the following document as proof of residence.

Nature of Document Date of issue Details of authority issuing certificate

(Authorised Signatory of notified Medical Authority (Name and Seal)

(Countersignature and seal of the CMO/Medical Superintendent/Head of Government Hospital, in

case the certificates issued by a medical authority who is not a permanent servant ( with seal)

Signature/Thumb impression of the person in whose favour disability certificate is issued.

Note: In case this certificate is issued by a medical authority who is not a government servant, it

shall be valid only if countersigned by the Chief Medical Officer of the District.

Annexure-XIV

Form of Certificate for serving Defence Personnel

I hereby certify that, according to the information available with me

(No.) _______________________ (Rank) _____________________________

(Name) ______________________________________ is due to complete the specified term of his

engagement with the Armed Forces on the (Date) ____________________.

Place: ………………………………… (Signature of Commanding Officer)

Date: ……………………………….. Office Seal:

Annexure- XV

UNDERTAKING TO BE GIVEN BY THE EX-SERVICEMAN CANDIDATES

I understand that, if selected on the basis of the recruitment/examination to which the

application relates, my appointment will be subject to my producing documentary evidence to the

satisfaction of the Appointing Authority that I have been duly released/retired/discharged from the

Armed Forces and that I am entitled to the benefits admissible to Ex-Servicemen (Ex-s) in terms of

the Ex-Servicemen Re-employment in Central Civil Services and Posts rules, 1979, as amended from

time to time.

I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-S in

regard to the recruitment covered by this examination, if I have at any time prior to such

appointment, secured any employment on the civil side (including Public Sector Undertakings,

Autonomous Bodies/Statutory Bodies, Nationalized Banks, etc.) by availing of the concession of

reservation of vacancies admissible to Ex-S.

I further submit the following information:

a) Date of appointment in Armed Forces __________________

b) Date of discharge ____________________

c) Length of service in Armed Forces __________________

d) My last Unit / Corps ____________________

(Signature of the Candidate)

Place: _____________

Date: _____________

application form for recruitment of prasar bharati...

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